Biomedical Research: “From the Envy of the World to the Puzzle of the World?”

“From the envy of the world to the puzzle of the world.” So said Dr. Frances Collins, director of the National Institutes of Health, in an interview at the Washington Ideas Forum earlier this month. As chair of an international group of research funding directors, Dr. Collins asked about biomedical science funding in each of their countries. The answers reflected an increase in funding across all countries — from 5% to 15%. They then asked Dr. Collins “How about the United States?” His answer? For the current year, we’d be lucky if we went down only by 5%. “Are you guys crazy?” the other national research funding leaders asked. “We’re reading your playbook from 10 years ago. Have you forgotten your own success story?”

Dr. Collins commented in the interview that we used to be the envy of the world in making discoveries that led to cures and economic progress, but “we are starting to be the puzzle of the world as people look at us and ask how we lost our way.” (Here’s the link to the full interview.)

There are many ways to think about the progress we have made due to scientific advances over the last century. Consider life-expectancy statistics: In 1900, life expectancy at birth was 47.9 years for men and 50.7 years for women. By 1950, these figures were 65.4 years for men and 71.0 years for women. In 2010, life expectancy increased to 76.2 years for men and 81.0 years for women.

During the first half of the century, the rise in life expectancy was due mainly to improvements in the prevention and control of major childhood infectious diseases and in nutrition, housing and hygiene, as well as better medical care. Improvements during the second half of the 20th century, however, were the result of the kinds of advances in biomedical science funded by NIH, particularly in relation to the treatment of cancer, heart disease and stroke, along with the promotion of healthier lifestyles.

For example, data from the American Cancer Society show the death rate from cancer in the US has fallen 20% from its peak in 1991, thanks to new treatments for cancer derived from biomedical research. This translates to almost 1.2 million deaths from cancer that were avoided. Even more dramatic are the data on declines in mortality rates from heart disease (338 deaths per 100,000 population in 1968 vs. 133 in 2008) and stroke (102 deaths per 100,000 population in 1970 vs. 44 in 2008).

NIH funding of investigator-initiated and other research grants, and the merit-based, peer-reviewed and highly rigorous methodology used to allocate its research funds, created an environment in the United States during the second half of the 20th century that attracted the best scientists nationally and internationally, and spurred a level of creative inquiry that was second to none in the world. Since 1950, 147 individuals have received the Nobel Prize in Physiology or Medicine (in many years the Prize is shared by two or three scientists). Although all scientists from around the world are eligible, 91 of 147 (or 62%) did their work in the United States (often having been born and educated in a different country). This past year, all three of the scientists who received the Nobel Prize in Physiology or Medicine, and all three who received the Nobel Prize in Chemistry, had been funded by NIH, but, according to Dr. Collins in his interview, all six felt that they may not have been awarded these grants using today’s cut-points for funding. Think about that.

When you think about things that the United States is really good at, besides basketball, biomedical research is high on the list. Why would we want to create deep, self-inflicted wounds in our biomedical research? Would France want to ravage its vineyards?

Over the past decade, the NIH budget has lost almost 25% less in purchasing power (i.e., adjusted for inflation). In the past several years (not counting the ARRA stimulus), there had been a gradual erosion of the NIH budget, and in FY13 the federal budget sequester — the poison pill that supposedly would never be swallowed because of the non-strategic nature of its across-the-board spending cuts — resulted in a massive $1.5 billion reduction. This led to NIH’s non-funding of 640 research projects during FY13 that received highly meritorious reviews and were initially approved for funding. If the sequester is left intact by Congress following current budget negotiations (i.e., if the negotiations fail), there will be an additional NIH budget cut of $600 million beginning January 1, 2014.

What a sorry state of affairs. At a time when the promise of biomedical science has never been greater, a time when the potential for breakthroughs has never been more exhilarating, as a nation we should not be mindlessly ravaging the work or our best scientists, destroying the biomedical research infrastructure needed for the future, and discouraging (to say the least) budding investigators from entering the field as a career. A perverse part of this story is that our legislators in Congress on both sides of the aisle generally endorse the need for greater support for NIH in a bipartisan manner. The problem is that our legislators cannot seem to come to agreement with regard to the overall federal budget. If it were conceded that some modification of Medicare and Social Security is needed to reflect growing life expectancies (in part due to medical advances from NIH discoveries!), and that budget gaps can be closed not solely by cutting costs but by increasing a modicum of revenues, a federal budget could finally be agreed upon and the across-the-board sequester could be replaced by a sensible combination of reductions in cost and increases in revenue. I know, call me crazy. And, to add to the fantasy, let’s posit that this sensible solution would also restore the NIH budget cuts and provide for a modest increase going forward.

The key theme for research in the UF Health Strategic Plan is to “reach for excellence.” Due to the recruitment of highly accomplished scientists over the past few years, and to the extraordinary efforts of existing faculty in writing competitive grants during the most challenging times in the history of the NIH, we have thus far been successful in swimming against the tide: During the FY11 and FY12 NIH budget years (which doesn’t count the ARRA stimulus), we have increased our NIH funding by about 15% per year, led by outsized increases in the colleges of Medicine and Public Health and Health Professions.

Moreover, we have a tremendous opportunity to build on this success due to the state’s commitment to “pre-eminence” funding to UF. Few universities are increasing their support of science during these challenging times, and researchers across the country are looking for environments that will nurture their work. We are now recognized as having such an environment. Several search committees across UF are hard at work in identifying the best investigators available, who will soon be making campus visits. We must proceed with appropriate caution, however. If the sequester continues, no scientist, including Nobel prize winners, can be assured of ongoing research funding.

Notwithstanding this caution, our glass is half-full. We fundamentally believe that the potential for science in improving the health of our nation, and in fostering economic progress, is so great that it cannot be ignored by our elected representatives. We sincerely hope that the success story of U.S. science is yet incomplete.

Along these lines, I will close with a quote from John Porter, who served for 21 years as a Republican congressman from Illinois, and who is now chairman of Research!America: “A nation’s leadership must view research through the prism of future generations: our children and grandchildren, who will benefit from both a health and economic standpoint as a result of today’s scientific discoveries. Imagine a world free of cancer, free of AIDS, free of Alzheimer’s, free of heart disease. It’s certainly possible if elected officials get beyond the rhetoric and take decisive action to strengthen our nation’s investments in research.”

Forward Together,

David S. Guzick, M.D., Ph.D. Senior Vice President, Health Affairs President, UF Health